OBJECTIVES: Type 2 diabetes mellitus (DM) represents an important public health issue and it is responsible for a significant epidemiologic and economic burden. A cost consequence analysis (CN), aimed at assessing the economic impact of sitagliptin (SITA), compared with sulfonylureas –SU (as second line therapy- add on to metformin) was peformed on the basis of the value based pricing approach. METHODS: A CN of SITA vs SU (glibenclamide5mg) was carried out, on a cohort of 1000 diabetic patients, from both the Lombardy Regional Health Service (RHS) and societal perspectives by considering 12 and 36 months time horizons. Direct (drug, automonitoring glycemic control, visits, hypoglicaemic- HYPOS- and CV events, and durability costs) and indirect costs have been considered. Epidemiologic and effectiveness data have been collected through available literature, trials and meta-analyses. Economic data have been retrieved through local/regional sources, tariffs and from available literature. RESULTS: The CN analysis shows that SITA+metformin vs glibenclamide+metformin represents a cost saving alternative, over 3 years time horizon, as higher drug costs of SITA are offset by : -          lower glycemic control, complications and durability costs resulting in a saving of almost €9.000 from RHS perspective -          lower productivity loss related to major cardiovascular and to HYPOS, leading to a saving of about €100.000 from societal perspective. Also, SITA vs SU would provide, from both perspectives, -236 not severe and -54 severe HYPOS and -14 CV events. The analysis performed over 12 months time horizon shows that SITA+metformin represents a sustainable alternative from both RHS and societal perspectives, by leading to a saving in terms of HYPOS 136 (118 not severe and 18 severe) and 7 CV events. CONCLUSIONS: The analysis performed shows that SITA represents a sustainable and cost saving alternative for the management of type 2 DM from both clinical and economic perspectives in Lombardy.